Wound digest
Australian Capital Territory. It involved a sample size of 96 patients at pre-audit and 95 patient at post-audit. A convenience sample of 20 nurses also consented to be observed.
n A skin tear is a traumatic wound that results from the separation of the skin layers due to shearing forces, friction or blunt trauma that affects all people. Numerous preventative measures aim to reduce the skin tears and minimise conditions that predispose the epidermis to injury. With the increasing elderly population in acute aged care, implementation of an evidence-based guideline is critical as changes to ageing skin integrity make this population more susceptible to skin tear.
n The aim of this project was to ensure the practice of skin tear assessment, prevention and management among acute aged care causes and rehabilitation patients was performed according to best available evidence.
n The results showed a significant change in compliance to the skin tear guidelines at post- implementation audit. Staff education in particular had a dramatic increase from 20% to 98% and the point prevalence rate of hospital-acquired skin tear decreased from 10% to 0.15%.
n This project emphasised the importance of education of all personnel involved in patient care and that a simple assessment of skin integrity is critical in preventing and managing skin tears, especially among the susceptible elderly population.
Lopez V, Dunk A M, Cubit K, Parke J, Larkin D, Trudinger M, Stuart M. Skin tear prevention and management among patients in the acute aged care and rehabilitation units in the Australian Capital Territory: a best practice implementation project. Int J Evid-Based Healthc 2011; 9: 429–434
Venous leg ulcers 3
Compression bandaging systems in patients with venous leg ulcers
Readability Relevance to daily practice Novelty factor
n This randomised controlled trial compared the clinical effectiveness of four-layer compression bandaging (4LB) (Profore®
Assessments included photogrammetry, Brief Pain Inventory, SF-12 Health Survey, Charing Cross Venous Ulcer Questionnaire and Frenchay Activity Index.
n At the time of the study, compression treatment was not considered usual care for venous leg ulcer patients in Hong Kong.
n A total of 321 patients participated in the study, 45 (14%) withdrew for various reasons. Compression bandaging in both groups significantly reduced pain (P < 0.0001) and improved functional status and QOL.
n Healing rate at 24 weeks for both compression groups was significant (P < 0.001) — the rate for SSB was 72% (77⁄107) versus 67% (72⁄107) in the 4LB group and 29% (31⁄107) in the usual care group. The reduction in ulcer area from weeks 12–24 was significant only in the SSB group (P < 0.047).
n Compression was shown to be feasible for elderly community care patients in Hong Kong and is currently implemented as part of standard venous leg ulcer treatment.
n Analysis was conducted using descriptive statistics for demographical and clinical data. Repeated measures analysis of variance (RMANOVA) was used to compare the differences in ulcer-related pain and QOL aspects comparing the three treatment groups over the 24-week study period. Ulcer healing time was compared using the log rank test. Kaplan–Meier survival curves were calculated for healing time and the Cox proportional hazard model was applied to compare the healing time between treatments, adjusting for potential confounders, such as baseline covariates, if these were unbalanced between treatment groups.
n All withdrawn cases were regarded as unsuccessful in terms of treatment and all variables, including size and pain score.
n Based on the present study’s results, it is statistically significantly evident that using compression with SSB or 4LB is more effective than usual care without compression. For healing time and faster reduction of ulcer area, as well as reduction of pain, the short- stretch bandage system exhibited superior results, improving patients’ QOL faster.
; Smith & Nephew) with
short-stretch compression (SSB) bandaging (Rosidal® sys; Lohmann & Rauscher), and usual care (moist wound healing dressing; no compression).
n This study was carried out over a 24–week period. The primary outcome was the patient functional status, disease–specific and generic health–related quality of life (QoL) measures and ulcer healing rates, comparing week 1 vs week 24 (end) results.
54 Wounds International Vol 3 | Issue 2 | ©Wounds International 2012
n The findings of the present study informed the allocation of health resources and the development of a specialised nursing service in the community setting. Compression therapy is now being implemented for patients receiving venous leg ulcer care in Hong Kong and is expected to be well accepted, even considering the hot, humid climate.
Wong IK, Andriessen A, Charles HE, Thompson D, Lee DT, So WK, Abel M. Randomized controlled trial comparing treatment outcome of two compression bandaging systems and standard care without compression in patients with venous leg ulcers. J Eur Acad Dermatol Venereol 2012; 26(1): 102-10.
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